NPIMap

Organization Active NPI

LHCG Lxxviii, LLC

Doing business as Jeff Davis MD Homecare

  • Home Health Agency
  • Jennings, LA
National Provider Identifier
1588112239
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LHCG LXXVIII, LLC
Doing business as
Jeff Davis MD Homecare
Practice address
1322 Elton Rd
Suite B
Jennings, LA 70546-4100
Phone
(337) 824-1188
Fax
(337) 824-7007
NPI assigned
Sep 12, 2016
Last updated
Sep 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald D. Stelly
Title
President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

1322 Elton Rd
Suite B
Jennings, LA 70546-4100

Mailing address

PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307

Other names 1

  • Jeff Davis MD Homecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161207001454 LA Part A Provider - Home Health Agency 8527348630 Practice locations: Jennings, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588112239. Details of each certification follow.

Home health agency certification: CCN 197039

Legal name
LHCG LXXVIII LLC
Doing business as
JEFF DAVIS MD HOMECARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 25, 1973
Last certification
Oct 7, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Jan 12, 2016 in LA
Enrollment address
1322 Elton Rd
Ste B
Jennings, LA 70546-4100

Care Compare: Home health agency

Medicare Care Compare
Listed as
Jeff Davis MD HomecareCCN 197039 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Jun 25, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0721865Jeff Davis MD Homecare1322 Elton Road, Suite B, Jennings, LA 70546Certificate of waiverOct 20, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Unitedhealth Group Incorporated Organization, Minnetonka, MN Corporation 5% Or Greater Indirect Ownership Interest Feb 22, 2023 90%
Marcus Donavon Macip Individual Corporate OfficerSecretary Feb 22, 2023
Kimberly Seymour Individual Corporate Officer Feb 22, 2023
Ramona M Comeaux Individual W-2 Managing EmployeeAdmin.Don Nov 1, 2016
Wendy S Daigle Individual Corporate DirectorDirector, Licensure & Regulatory Oct 1, 2022
LHC Group Inc Organization, Lafayette, LA Corporation 5% Or Greater Indirect Ownership Interest Nov 1, 2016 90%
Joshua Lee Proffitt Individual Corporate OfficerPresident Nov 1, 2016
Hep Holding LLC Organization, Jennings, LA LLC 5% Or Greater Direct Ownership Interest Nov 1, 2016 10%
Louisiana Health Care Group LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Nov 1, 2016 90%

Facilities with the same owner 44

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 44

Change-of-ownership history 1

DateEventCounterparty
Nov 1, 2016 Change of OwnershipThis provider was the buyer Jeff Davis Home HealthCCN 197039, LA, NPI 1316994817

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 23

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1588112239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51266",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705051266",
            "telephone_number": "337-233-1307",
            "fax_number": "337-233-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 ELTON RD",
            "address_2": "SUITE B",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705464100",
            "telephone_number": "337-824-1188",
            "fax_number": "337-824-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LHCG LXXVIII, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-12",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "STELLY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeff Davis MD Homecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jennings, LA

Sources for this page

Verify at the official NPI Registry.